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f <br /> ELECTRICAL PERIT APPLICATION - <br /> tip CITY OF EVERETT PERMIT SERVICES <br /> vidO3200 CEDAR STREET, EVERETT, WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> --) PROJECT SITE INFORMATION <br /> PROJECT ADDRE <br /> / _'y � !"°f <br /> BUILDING AREA(i residentia, new construction,remodel,or addition) SF <br /> BUILDING TYPE: 0S � �' � �-DETACHED 0 SFR-ATTACHED DUPLEX 0 MULTI-FAMILY-#OF UNITS: 0 COMMERCIAL <br /> USE OF BUILDING: 1. FA-44/d "11)21/1"/ <br /> ELECTRICAL APPLICATION INFORMATION <br /> CONTRACT PRICE OF WORK:$ L( ., <br /> NUMBER OF DEVICES(if low voltage): <br /> FIRE ALARM? DYES <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> DES RIPTION OF WORK: <br /> `./ lt, b--tel Vii- Pfrytia5 / 1 - & °' ANdi <br /> i <br /> CONTACT INFORMATION <br /> . - VAI-De.;; 2. (IfCommercial): <br /> OWNER NAME: � TENANT NAME <br /> OWNER MAILING ADDRESS: STREET ili .5.. <br /> CITY '01/ . - STATE P ZIP elk2641 <br /> . <br /> OWNER PHONE: 91,„1,-, "'. '" OWNER EMAIL: -,5ki.-V <br /> +C <br /> CONTRACTOR NAME: C „ / _ ! r ` ✓ i <br /> CONTRACTOR ADDRESS: STREET /552045/ i ,-/ �. ' e`p e` �g <br /> CCm. ',()it. ,(1 - STATE ZIP "[ h P <br /> CONTRACTOR PHONE: 4/1- -" °" (w -- 7/ark CONTRACTOR EMAIL: g4V/ ff.,)t C" ~ .iriC s ive <br /> t� <br /> CONTRACTOR LIC.#(REQUIRED): -EC P mal t CITY OF EVERETT BUSINESS LIC.#(REQUIRED): e--Yv F C..k- <br /> PRIMARY CONTACT: 0 OWNER { CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: _ i 41.') .�, CONTACT PHONE: , Tt� ' "7 - / ,✓ '_ <br /> A C-b i CONTACT EMAIL: 7 ,<. ✓d t . . ,-. L r <br /> AGREEMENT:I hereby certify tha I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type <br /> of work will be completed whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or <br /> local law regulating construction or the performance of construction. That I am authorized by the owner of this property to perform the work for which application is made and! <br /> comply with the State Contractors Law 18.27 RCW and 296.200 WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Poi E \ O1,- 12 <br /> Owner Authorized Agent Signature Date (Revised 9123/2018) <br />